Worked example 1
A 22-year-old reports hearing voices commenting on their behaviour for six weeks. They believe neighbours are controlling their thoughts. Affect is flat and they have stopped attending university.
(a) Outline the positive and negative symptoms shown. [4 marks] (b) Using Rosenhan (1973), evaluate the validity of schizophrenia diagnosis. [6 marks]
Show solution outline
(a) AO1 — Positive symptoms:
- Auditory hallucinations — hearing voices commenting on behaviour.
- Delusions — belief that neighbours control thoughts (delusion of control/persecution).
AO1 — Negative symptoms:
- Flat affect — reduced emotional expression.
- Avolition — withdrawal from university, loss of goal-directed activity.
(b) AO1 — Rosenhan (1973): Eight sane pseudopatients presented vague symptoms and were all admitted with schizophrenia diagnoses; once inside, normal behaviour was reinterpreted within a psychiatric label.
AO3 — Evaluation:
- Supports invalidity: Shows diagnosis may be over-inclusive and context-dependent — staff expected illness and interpreted normal behaviour pathologically.
- Methodological critique: Small sample, dated institutions, deception ethics — limits generalisability to modern DSM-5/ICD-11 practice.
- Counter-evidence: Improved structured interviews (e.g. SCAN) and explicit criteria aim to increase inter-rater reliability — Rosenhan highlights risk, not inevitability, of misdiagnosis.
Judgement: Rosenhan usefully warns that validity depends on distinguishing genuine psychosis from situational mislabelling — but modern criteria and duration rules (as in this case) aim to reduce false positives.